EP0589454A2 - Instrument de chirurgie endoscopique - Google Patents

Instrument de chirurgie endoscopique Download PDF

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Publication number
EP0589454A2
EP0589454A2 EP93115357A EP93115357A EP0589454A2 EP 0589454 A2 EP0589454 A2 EP 0589454A2 EP 93115357 A EP93115357 A EP 93115357A EP 93115357 A EP93115357 A EP 93115357A EP 0589454 A2 EP0589454 A2 EP 0589454A2
Authority
EP
European Patent Office
Prior art keywords
blade
handle
blade members
members
cutting
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP93115357A
Other languages
German (de)
English (en)
Other versions
EP0589454A3 (en
Inventor
Ernie Aranyi
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
United States Surgical Corp
Original Assignee
United States Surgical Corp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by United States Surgical Corp filed Critical United States Surgical Corp
Publication of EP0589454A2 publication Critical patent/EP0589454A2/fr
Publication of EP0589454A3 publication Critical patent/EP0589454A3/en
Withdrawn legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3201—Scissors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B26—HAND CUTTING TOOLS; CUTTING; SEVERING
    • B26B—HAND-HELD CUTTING TOOLS NOT OTHERWISE PROVIDED FOR
    • B26B13/00—Hand shears; Scissors
    • B26B13/06—Hand shears; Scissors characterised by the shape of the blades
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2945—Curved jaws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/1425—Needle
    • A61B2018/1432—Needle curved

Definitions

  • the present invention relates to endoscopic surgical instruments, and more particularly relates to an endoscopic instrument having reciprocating jaw members which pivot in response to the opening and closing of a handle member, where the movement of the handles is translated through an elongated tubular body member to open and close the jaw mechanism.
  • the present invention further provides a device in which the jaw mechanism may comprise cutting scissor blades, a gripping device for holding tissue during surgery, holding surgical needles and the like.
  • the device of the present invention may be provided with a rotatable tubular body for selectively positioning the angle at which the jaw mechanism operates, and provision is also made for the use of electrocautery capabilities to provide for cauterization at the surgical site.
  • various endoscopic surgical instruments which utilize generally complex mechanisms for opening and closing handle members and jaw members to facilitate use of the device at a surgical site.
  • Many devices provide an intricate construction in which a linkage mechanism for opening and closing the jaws requires numerous moving parts, while a sliding arrangement is provided between two extended rod members which activates the linkage mechanism in response to movement of the handle members.
  • pivoting of the handle members in many cases causes an unwanted radial torquing force on the rod which requires additional space to be provided in the handle members to accommodate the radial movement of the rod.
  • Endoscopic devices presently in use include many devices having an interchangeable shaft assembly and jaw mechanism in which a common reusable handle may be used with a series of instruments.
  • these devices suffer disadvantages in that the connecting mechanism oftentimes obstructs the view of the surgeon, and the integrity of the device may be decreased due to loosening of the connection.
  • These disadvantages are critical due to the fact that an endoscopic surgical procedure requires precision instruments with tolerances that are carefully monitored. As the connections wear, precision is sacrificed, and the usefulness of the tool is diminished.
  • U.S. Patent No. 4,674,501 discloses a surgical instrument having a pair of reciprocating shafts which are provided with a rotational indexing knob in which the shafts are allowed to rotate to position a cutting tool at a specific angle to the handles.
  • the shafts slide on top of each other in response to opening and closing of the handle members to open and close the jaw members of the cutting instrument.
  • the housing is secured to a stationary handle, such that the shaft assembly rotates with the indexing knob.
  • One shaft is secured in a ball and socket joint to a movable handle which facilitates the sliding arrangement of the movable shaft over a stationary shaft.
  • the handle assembly is disengagable from the housing by means of a screw, and the ball joint slides out of the socket to remove the handles.
  • Ger, U.S. Patent No. 4,919,152 discloses a clip applying device having a stationary handle and a pivoting handle to which an elongated shaft arrangement is attached. At the end of the shaft is a pair of reciprocating jaw members which are operated in response to pivoting movement of the handles.
  • An inner shaft member is attached to the pivoting handle, the shaft member passing through an outer tube member which is attached to the stationary handle.
  • the bushing member is necessary inside the stationary handle to accommodate the radial play in the rod member during opening and closing of the handles.
  • Straub et al. U.S. Patent No. 4,590,936, discloses a microsurgical instrument having a complex gear mechanism for translating movement of the handles to an opening and closing movement of the jaw members.
  • a helical slot is provided in a shaft member which allows a pin to move through the slot to move the jaw members.
  • a ball and socket joint is provided in the movable handle to connect the movable handle to the inner rod.
  • Endoscopic surgical instruments are known in the art which include cooperating cutting blade members.
  • a gap between the blade portions is evident when the blades are engaged for cutting.
  • a gap between the blades is undesirable because it detrimentally affects cutting precision.
  • the surgeon cannot achieve the clinical results desired, and in some cases, for example, ripping or tearing of tissue may occur.
  • prior art endoscopic surgical instruments are known to suffer from undesirable splaying of the blade members.
  • at least one blade member is movably attached to a pivot point.
  • the blade members When the blade members are repeatedly used, or encounter a hard substance during use, the blade members will tend to move laterally apart from one another, or splay. Blade member splaying increases the gap between the blade surfaces, and detrimentally affects cutting ability and precision.
  • blade overstroke occurs when the blade surface of at least one movable blade member surpasses the desired closed cutting position of the reciprocating blade.
  • the novel endoscopic surgical instrument pursuant to the present invention obviates the disadvantages encountered in the prior art and provides a precise instrument which is easy to manufacture and efficient to use, which eliminates many of the moving parts required by prior art devices.
  • the instrument of the present invention incorporates many features which are of use to the surgeon during an operation, while it maintains a lightweight construction in an easy to handle device in which all the features may be operated with one hand. Furthermore, the features are so positioned so as to provide a maximum line of sight for the surgeon without obstructing the view to the surgical site.
  • the present invention provides a novel endoscopic surgical device which incorporates many features necessary for an endoscopic surgical procedure, and provides a lightweight and easy to use device which may be operated with one hand.
  • the device is simple to manufacture, and may incorporate any one of a series of jaw mechanisms for various surgical procedures.
  • the device is a high precision instrument in which many moving parts normally associated with such a device are eliminated, thus reducing instances of mechanical failure requiring expensive repair or ultimate destruction of the instrument.
  • the endoscopic surgical instrument of the present invention essentially consists of a handle assembly, an elongated body assembly, and a tool mechanism attached at a distal end of the body assembly remote from the handle assembly.
  • the handle assembly includes a stationary handle and pivoting handle, whereby the body assembly is attached to the stationary handle assembly and extends therefrom.
  • the body assembly consists of an outer tubular member and an inner rod member which coaxially passes within the outer tubular member.
  • the rod member is attached to the pivoting handle, while the tube member is secured in a conventional manner to the stationary handle.
  • the outer tube is provided with a detent which cooperates with a boss on the interior of the stationary handle to lock the outer tube in place. As the pivoting handle moves, the rod member slidably reciprocates within the outer tube member.
  • the tool mechanism which opens and closes in response to movement of the pivoting handle in relation to the stationary handle.
  • the tool mechanism may comprise a pair of jaw members wherein one or both jaw members open and close to perform various endoscopic surgical procedures.
  • the jaw mechanism includes, but is not limited to, a scissor device, a dissecting device, a grasping device and the like.
  • the jaw mechanism is secured to the outer tubular member by means of a transverse post member which serves as a common pivot point about which both jaw members pivot.
  • Each jaw member is provided with a camming portion which extends away from the pivot point, and consists of a cam slot which extends from the pivot point into the outer tube.
  • the upper jaw is generally provided with a pair of spaced apart projections, each provided with a cam slot which transversely overlap each other.
  • the lower jaw is also provided with a pair of extensions which are spaced apart a distance which is less than the space between the projections of the upper jaw member so that the lower projections pass between the upper projections.
  • the lower projections are also provided with transverse overlapping slots which are positioned at an angle to the upper cam slots.
  • each jaw may be provided with a single projection particularly if the jaw comprises a scissor blade.
  • the jaw mechanism is secured to the outer rod through the common pivot point.
  • the inner rod member is provided with a bearing surface, which typically comprises a post member which passes through and is engaged within the cam slots of both jaw members.
  • a bearing surface typically comprises a post member which passes through and is engaged within the cam slots of both jaw members.
  • the pivoting handle is provided with a pair of stop members which are positioned proximate the pivot point which secures the pivoting handle to the stationary handle, and about which the pivoting handle moves.
  • the upper, or proximal stop member abuts a boss within the stationary handle to prevent the jaw mechanism from opening too wide, while a distal, or lower stop member abuts the stationary handle to prevent excessive forces from being applied to the jaw mechanism during closing.
  • the application of force to the jaw mechanism may be regulated during design and manufacture by the interengagement of the stop members on the pivoting handle with the bosses on the stationary handle.
  • a novel feature of the present invention is the provision of a second pivot point on the pivoting handle, to which the inner rod member is attached. As the handle pivots, the second pivot point rotates to allow the inner rod to move longitudinally in the outer tube with minimal radial deflection.
  • This is an important feature of the present invention in that it reduces the radial wear on the inner rod and prevents weakening of the structure during long term use. In addition, it allows for a reduction of the required internal spacing between the outer tube and the inner rod to result in a more compact and streamlined instrument. Furthermore, unwanted torquing forces are eliminated at the pivot point thus minimizing the possibility of mechanical breakdown of the instrument at the connection between the pivoting handle and the movable inner rod.
  • connection port may also feature a connection port to provide the device with electrocautery capabilities.
  • a connection port is provided, preferably on the stationary handle on the side of the longitudinal axis opposite the finger grip portion.
  • the connection port is positioned at an angle to the longitudinal axis, which is preferably less than 30° and in a preferred embodiment is approximately 9° to the longitudinal axis, and extends in a direction away from the body assembly. In this way, the surgeon's line of sight is unobstructed and provides a clear view to the surgical site.
  • the connection port allows for the connection of a suitable jack member to be inserted into the device.
  • Electrical connection between the port and the outer tube is provided by a leaf spring member which extends from the port area to the outer tube.
  • the outer tube is provided with electrical insulation, preferably heat shrink tubing, which extends a substantial portion of the length of the outer tube.
  • the handle is molded of plastic material to provide electrical insulation to the user.
  • the electrical port connection may be provided adjacent the finger grip of the stationary handle, so that the jack member extends downwardly away from the device to insure an unobstructed line of vision for the surgeon.
  • a leaf spring member extends from the port through the stationary handle to the outer tube to complete the electrical connection.
  • a further feature of the present invention is the provision of a rotatable knob on the outer tubular member to allow the body assembly and the jaw mechanism to rotate to position the jaws at desired angles to the longitudinal axis during the surgical procedure.
  • the rotatable knob is secured to the outer tube and positioned in a slot which passes through the stationary handle, so that a surgeon may rotate the knob, and consequently the body assembly and jaw mechanism, through the use of his thumb while he is holding the stationary handle with his fingers. This frees the surgeon's other hand to simultaneously operate another instrument during surgery.
  • the rotatable knob is secured to a bushing, which in turn is secured to the outer tube member.
  • the bushing is provided with a polygonal cross-section, which corresponds to a boss member within the interior of the stationary handle. This allows for incremental rotation of the body assembly and jaw mechanism to desired angles to the longitudinal axis.
  • the bushing has a dodecahedral cross-section.
  • all the above features are incorporated into a single endoscopic surgical instrument, so that the instrument has electrocautery and rotational capabilities.
  • the instrument may be constructed without one or more of the features while still providing a lightweight precision instrument.
  • an endoscopic surgical instrument including a handle assembly, and a body assembly including an outer tube member and a rod member cooperating with the handle assembly.
  • a tool mechanism includes a pair of reciprocating members pivotally secured to a distal end of the body assembly cooperating with the handle assembly.
  • the reciprocating members of the tool mechanism include a blade portion which each have a blade edge, and in a preferred embodiment, at least one of the blade edges includes an inflected surface.
  • the inflected surface substantially closes a gap between the cooperating blade surfaces. The enhanced cooperation between the blade surfaces enables the surgeon to meet critical tolerances in surgical operations, and provides a precision shearing action to cut tissue.
  • the endoscopic surgical instrument further provides a tube portion at a distal end of the body assembly.
  • the tube portion substantially prevents the reciprocating members from laterally separating.
  • the endoscopic surgical instrument also provides an abutment member coupled to at least one of the reciprocating members.
  • the abutment member cooperates with the outer tube member of the body assembly. The mutual cooperation between the abutment member and the outer tube member discourages the closed reciprocating members from becoming overstroked.
  • Another embodiment of the present invention provides a cutting mechanism for shearing tissue in which the cutting mechanism is particularly suited for shearing thick tissue and for use in endoscopic surgical procedures where it may be necessary to cut staples or sutures inside the patient's body.
  • the cutting mechanism is for use with an endoscopic surgical instrument which includes the handle mechanism and elongated body portion as described above, and preferably includes a pair of crescent shaped blade members which taper in thickness from the connection point at the body assembly to the tip of the cutting mechanism.
  • the crescent shaped blade members are positioned in overlapping relation and preferably have different radii of curvature relative to the pivot point so that when the cutting mechanism is constructed the blades contact each other at a single point along the cutting edge to enhance the shearing effect of the scissors and to reduce the incidence of the blades separating during cutting. While the radii of curvature may be the same at the cutting edge surface of each blade member, when the cutting mechanism is assembled the radii of curvature for the two blade members are different relative to the pivot point.
  • the blade members preferably are metal injection molded and then ground to provide a precision cutting edge surface on the blade members.
  • a further feature of the cutting mechanism of the present invention is the provision of a relief angle on the surface of the blade members that face each other where that surface is angled toward the cutting edge to further enhance the shearing effect. The relief angle is formed during grinding of the blade member.
  • Fig. 1 illustrates an embodiment of the endoscopic surgical instrument 10.
  • the device comprises a handle assembly 12 which consists of a stationary handle 14 and a pivoting handle 16. Extending from the handle assembly is a body portion 18 which comprises an outer tubular member 20 through which a slidable inner rod member 22 passes in coaxial relationship.
  • the outer tube 20 is secured to the stationary handle 14, while the inner rod 22 is secured to pivoting handle 16 at rotatable connection point 26.
  • Handle 16 pivots about pivot point 24 to move in relation to stationary handle 14.
  • a tool mechanism 28 Attached at a distal end of the body portion 18 is a tool mechanism 28, which essentially consists of a lower jaw member 30A and an upper jaw member 30B.
  • the tool mechanism is connected to the body portion 18 at pivot point 32 and moves in a reciprocating manner about pivot point 32 through the provision of linkage mechanism 34.
  • Linkage mechanism 34 will be described in greater detail below.
  • connection point 26 In use, as pivoting handle 16 pivots about pivot point 24 in relation to stationary handle 14, inner rod 22 reciprocatingly slides within outer tube 20 in response to the push or pull force at connection point 26.
  • connection point 26 The function of connection point 26 will be described in greater detail below.
  • Jaw members 30A and 30B may comprise scissors, dissecting jaws, or a grasping mechanism, or any other tool mechanism required for specific surgical procedures.
  • pivoting handle 16 is provided with a pair of stop members 36A and 36B which cooperate with boss members 38A and 38B, respectively, to limit the rotational movement about pivot point 24 of the pivoting handle 16.
  • the stop members are positioned on opposite sides of pivot point 24 so that when pivoting handle 16 is moved away from stationary handle 14, proximal stop 36A contacts boss 38A to limit the actual rotation of handle 16.
  • distal stop 36B contacts boss 38B to limit the rotation of handle 16 in that direction.
  • the stop members are provided to prevent the application of excessive forces on the tool mechanism during opening and closing of the surgical instrument. In this manner, the possibility of damage or destruction of the tool mechanism is greatly reduced or eliminated.
  • FIG. 3 illustrates a first alternate embodiment 10A of the endoscopic surgical instrument of the present invention.
  • Instrument 10A is similar to instrument 10 except for the provision of an electrocautery connection to allow for cauterization of tissue at the surgical site during the surgical procedure.
  • Stationary handle 14 is provided with a connection port 42 for the reception of an electrical jack member (not shown) for providing the necessary current to the tool.
  • a leaf spring 44 electrically connects port 42 with outer tube member 20 which carries the electric current to the tool mechanism at the surgical site.
  • the leaf spring is provided with a connection member 46 at the port 42 and a connection member 48 at the outer tube.
  • the connection members essentially rely on the resiliency of the material which comprises the leaf spring, but of course may be any conventional electrical connection.
  • the handle is preferably constructed of a rigid plastic material which renders the device lightweight and electrically insulated.
  • an insulation member 40 is provided on outer tube 20, the insulation member preferably consisting of heat shrink tubing. Heat shrink tubing 40 passes into stationary handle 14 to prevent the possibility of electric shock.
  • connection port 42 is shown as being attached to stationary handle 14 at the finger grip, it is also contemplated to position the connection port on top of the handle as shown and described below in relation to Fig. 5.
  • the positioning of the connection port in the present invention is such so as to provide the surgeon with an unobstructed line of sight down body member 18 to view the surgical site at the tool mechanism 28.
  • Fig. 4 illustrates a preferred embodiment of the invention, in which the instrument 10B is provided with the electrocautery feature as well as having provisions for a rotatable body portion 18.
  • a slot 54 is provided in stationary handle member 14 which passes completely through the handle member.
  • a rotatable knob 52 Positioned within the slot 54 is a rotatable knob 52 which is fixedly secured to outer tube 20 through the provision of a bushing member 56.
  • the rotatable knob 52 and bushing member 56 will be described in greater detail below.
  • inner rod member 22 is connected to pivoting handle 16 through the provision of a rotational bushing 58.
  • Bushing 58 pivots during movement of pivoting handle 16 so that as rod member 22 is reciprocated within tube 20, the bushing member 58 rotates to minimize or eliminate any radial movement of rod 22, to insure that rod 22 moves in a longitudinal direction only. This alleviates excessive torquing forces on rod member 22 as well as unwanted excessive forces at the connection point 26 to prevent damage to the handle or the inner rod member 22.
  • rotational bushing member 58 Another feature provided by this rotational bushing member 58, is that by greatly reducing or eliminating radial movement of rod member 22, exact tolerances between the outer tube 20 and the inner rod member 22 may be maintained, so that less spacing is required and the instrument may be made in a smaller size than conventional endoscopic instruments. In addition, by greatly reducing or eliminating the radial deflection, the precision of the instrument is greatly enhanced.
  • the features of rotational bushing member 58 will be described in greater detail below.
  • FIG. 5 shows handle member 14A in a side cutaway view, and is the preferred embodiment of the present invention.
  • handle member 14A and handle member 16A are attached at pivot point 24 so that during opening and closing of the handle assembly, proximal stop member 36A contacts boss 38A to limit rotation of pivoting handle 16A away from stationary handle 14A.
  • stop member 36B contacts boss member 38B to limit rotation in that direction.
  • Locking mechanism 64A and 64B may be utilized to position the handles at various locations during the opening and closing procedure, which of course allows for the application of various closing forces on the tool mechanism at the distal end of the instrument.
  • Handle 14A is provided with a slot 54 which accepts the rotatable knob 52.
  • a polygonal shaped boss structure 57 is provided in the handle which will accept the corresponding polygonal shape of bushing member 56 when the instrument is constructed.
  • the cooperation between structure 57 and bushing 56 allows for the incremental rotation of the body portion 18, and consequently the tool mechanism 28 to position the tool mechanism at various points along the rotational path.
  • the number of faces presented by boss structure 57 is equivalent to the number of faces on the polygonal cross-section of bushing 56.
  • each structure has 12 faces.
  • Fig. 5 illustrates the preferred location of the electrical port 60, that being at the top of handle member 14A positioned at an angle to the longitudinal axis of the instrument formed by the body portion 18.
  • Port 60 is preferably positioned at an angle of less than 30° to the longitudinal axis, and in its most optimal position, is positioned at 9° to the longitudinal axis. This affords the surgeon a clear line of sight down the longitudinal axis of the instrument to view the procedure at the surgical site.
  • Port 60 accepts an electrical jack member through hole 61, and an electrical connection is made through the provision of a leaf spring member held in track 62 which connects the jack (not shown) with the outer tube member as seen at 63.
  • Figs. 6A and 6B illustrate the tool mechanism which consists of, for example, a scissor mechanism including scissor blades 72 and 74.
  • a housing member 66 is attached to outer tube 20, and the tool mechanism is attached to housing member 66.
  • Housing member 66 is shown in detail in Figs. 11A and 11B, in which a diametric radial hole 67 is provided to accept pivot pin 68 to allow the tool mechanism to pivot about pin 68 during opening and closing.
  • Housing member 66 is provided with a longitudinal slot 70 which allows the jaw members which comprise the tool mechanism to open and close, as best seen in Figs. 11A and 11B.
  • stiffening members 75 may be provided on scissor blades 72 and 74 which reinforce the blades and add strength to the blades. Stiffening members 75 allow for a very thin construction for blades 72 and 74, particularly at the distal end 77. Stiffening members 75 may comprise a detent or outwardly punched region whose addition to blades 72 and 74 bias the blades towards each other to enhance the shearing function of the blades. As the blades are made thinner, the resiliency of the blade material, preferably stainless steel, titanium, or a like metal, tends to decrease, and the provision of stiffening members 75 urges the blades 72 and 74 toward each other to maintain the efficiency of the cutting action. It is also contemplated that stiffening members 75 may comprise a built up region of material, or a layer of material fastened to the blades by adhesives, solder, or the like.
  • scissor blades 72 and 74 are shown in the open position whereby the handle members (not shown) are in the open position, i.e., pivoting handle 16 is moved away from stationary handle 14.
  • scissor blades 72 and 74 are provided with cam slots 76 and 78, which slots accept a bearing post 80 which is attached to inner rod 22.
  • bearing post 80 slides within cam slots 76 and 78 to pivot blades 72 and 74 about stationary pivot point 68 to open and close the blades.
  • the tail end of the blades pass through slot 70 in housing member 66 to allow the blades to open.
  • FIG. 6C Another embodiment of the endoscopic surgical instrument 10 is shown in Fig. 6C.
  • the endoscopic surgical instrument includes a tool mechanism 28A having scissor blades as in the previous embodiment shown in Figs. 6A and 6B.
  • each scissor blade 72, 74 includes a blade edge 158 and an inflected surface 160 which is directed away from the outer surface of the blade and towards the opposite blade.
  • the reciprocating blades when the reciprocating blades are in a closed position a gap may exist between the blades.
  • Endoscopic surgical procedures require precision cutting action and superior cutting ability.
  • the inflected surfaces 160 substantially contact continuously along the blade edge 158 when the scissor blades 72, 74 are in mutual cooperation, thereby eliminating any gap between the blade surfaces.
  • the endoscopic surgical device as described above and illustrated in Fig. 6C may include an inflected surface 160 on only one cooperating scissor blade.
  • the scissor blades 72, 74 communicate in the same fashion as described above.
  • the inflected surface 160 may be manufactured, for example, by rolling or grinding a portion of the blade edge 158 after the blade edge 158 is cut or stamped from, for example, steel.
  • a metal harder than the steel fabricated blades, such as, for example, carbide steel is used to roll or grind the inflected surface.
  • the inflected surface 160 preferably may be, for example, at an acute angle to a vertical plane in which the blade edge 158 lies.
  • the acute angle for example, preferably may be between 40 degrees and 50 degrees.
  • the acute angle for example, most preferably may be 45 degrees.
  • the inflected surface 160 preferably may extend, for example, between .0009 inches and .003 inches from the blade edge at a desired angle. Moreover, the inflected surface 160 most preferably may extend, for example, between .001 and .002 inches from the blade edge at a desired angle.
  • Fig. 7 illustrates an exploded perspective view of a dissector device which may comprise tool mechanism 28.
  • outer tube 20 is provided with a slot 21 which allows for the opening and closing of the dissector members.
  • housing member 66 is eliminated.
  • the dissector members 82 and 84 are provided with a cam slot arrangement similar to the device illustrated in Fig. 6B.
  • Cam slot 86 is provided on upper dissector member 82
  • cam slot 88 is provided on lower dissector member 84.
  • inner rod 22 is positioned within outer tube 20, while dissector members 82 and 84 are pivotally secured to outer tube 20 by means of pivot pin 68 which passes through hole 69 in tube 20.
  • Rod 22 is secured to the cam slot arrangement through the provision of bearing post member 90.
  • bearing post 90 slides in cam slots 86 and 88 to pivot the dissector members about pivot point 68 to open the members, and when the rod member 22 is slid away from the dissector mechanism, post 90 slides in cam slots 86 and 88 away from the dissector mechanism to draw the dissector members 82 and 84 into a closed position, as best seen in Fig. 9.
  • Figs. 8A and 8B illustrate the preferred embodiment of the dissector device, in which the body portion has a crescent shape to facilitate grasping and tearing tissue.
  • the surface of the dissector members include serrations 98 which are provided for dissecting and tearing tissue during a surgical procedure.
  • Overlapping projections 94 and 96, on which cam slots 86 and 88 are formed, allow the dissector mechanism to open and close without interfering with each other.
  • the spacing between projections 94 is less than the spacing between projections 96, such that projections 94 fit within projections 96.
  • Slot 21 is provided on outer tube 20 allow the projections to pass outside the perimeter of tube 20 to allow the dissector mechanism to open and close.
  • Figs. 10A through 10E illustrate a grasping mechanism which may be used as the tool mechanism on the endoscopic surgical instrument of the present invention.
  • Figs. 10A and 10B illustrate a cooperating pair of grasping members 100 and 102 which are provided with serrations 104 to facilitate the grasping and holding of tissue.
  • the body portions 100 and 102 are preferably constructed of a plastic material which is integrally molded about projection 106.
  • a post member 110 is provided about which the members 100 and 102 are molded.
  • Projection 106 is provided with cam slot 108 and pivot hole 109 so that the grasping mechanism may be operated in a manner similar to that previously described above in connection with the scissor mechanism and the dissector mechanism.
  • Figs. 10D and 10E illustrate the grasping mechanism of Figs. 10A through 10C except where the entire mechanism is constructed of metal, such as stainless steel, titanium, cast aluminum or the like.
  • Projections 112 and 114 cooperate in a manner similar to that described above for the dissector device, where projections 112 are spaced greater than the distance between the projections 114 so that projections 114 may pass between projections 112 during opening and closing of the grasping device.
  • Figs. 12 and 13 there is illustrated the rotatable knob 52 and bushing member 56 which are used in connection with the rotatable body portion to rotate the body portion and tool mechanism.
  • Rotatable knob 52 is preferably knurled or provided with ridges 116 to allow for easy manipulation by the surgeon's thumb or fingers.
  • Rotatable knob 52 is preferably hollow and includes a passageway 118 to allow the bushing member 56 to pass therethrough.
  • Fig. 13A illustrates the bushing member as having a polygonal cross-section, such that it is provided with a series of faces 126 which cooperate with faces 125 on the rotatable bushing. The bushing extends outwardly from rotatable knob 52 (see Fig.
  • Fig. 13B best illustrates boss member 124 which allows for connection and securement of the bushing to outer tube 20. Boss 124 fits into a groove or slot in tube 20 to secure the bushing and rotatable knob to outer tube 20. It is also contemplated that bushing 56 and rotatable knob 52 are constructed as a single integral unit. Knob 52 and bushing 56 are preferably constructed of plastic, so that insulation is provided during use of the electrocautery feature.
  • the positioning of the rotatable knob on the stationary handle allows the surgeon to use the endoscopic surgical instrument 10B with one hand, so that as the surgeon is holding the device he may rotate the knob with his thumb while keeping his other hand free to control the surgical procedure.
  • Pivot bushing 58 is best illustrated in Figs. 14A and 14B and comprises a pair of discs 128 each having a post member 130 and a hole 132 formed therein for interengaging the discs with each other. Groove 134 is provided with a notch portion 136 which accepts the end of rod member 22 which is formed with a corresponding notch. This notch secures rod 22 in place for longitudinal movement, while at the same time allowing for rotational movement. As stated above, as handle member 16 pivots, bushing 58 rotates to greatly reduce or eliminate radial deflection of the rod member within the tube. This alleviates the torquing forces on the rod and minimizes damage to the device after extended use.
  • Figs. 15A and 15B illustrate a further embodiment of the tool mechanism in accordance with the present invention.
  • Stationary scissors blade 140 is attached to movable scissors blade 142 about transverse stationary pivot pin 144.
  • This transverse pin 144 is attached to housing member 66 through radial hole 67 as discussed above (see Figs. 11A and 11B).
  • the present scissors embodiment utilizes a shearing motion of blades 140 and 142 in order to separate tissue.
  • Arcuate cutting surfaces, 146 and 148 respectively, are formed on opposed vertical faces of the distal ends of blades 140 and 142 to better facilitate the shearing cutting action.
  • a spring washer 150 see Fig. 15C, is provided to urge movable blade 142 against stationary blade 140. The urging force providing a better cutting action as the blades 140 and 142 shear against each other.
  • a transverse bearing post 152 is attached to inner rod 22 and adapted for reciprocal longitudinal motion within outer tube 20.
  • a longitudinal slot 154 is provided in a proximal end of stationary blade 140 in an area proximal to and in longitudinal alignment with transverse pivot pin 144.
  • Bearing post 152 interfits with slot 154 for longitudinal motion therein and serves to prevent pivotal motion of blade 140 about pivot pin 144.
  • An arcuate cam slot 156 is provided in a proximal end of movable blade 142 in an area proximal to transverse pivot pin 144.
  • Bearing post 152 interfits within arcuate cam slot 156 and serves to translate the longitudinal motion of inner rod 22 relative to outer tube 20 into pivotal motion of blade 142 about pivot pin 144.
  • blade 142 is cammed open relative to blade 140 which remains in the same longitudinal plane as rod 22.
  • proximal motion of rod 22 causes bear post 152 to cam blade 142 to a closed position as shown in Fig. 15B.
  • This embodiment is directed to a shearing scissors mechanism, however, other mechanisms such as, for example, graspers, dissectors, clamps etc. are contemplated.
  • FIG. 16-23 Another embodiment of the endoscopic surgical instrument 10 is shown in Figs. 16-23.
  • the endoscopic surgical instrument 10 includes a tool mechanism 28B having a stationary blade 140 and a movable blade 142 cooperating with a handle assembly 12 by an inner rod member 22 as in the previous embodiment shown in Figs. 15a and 15b.
  • the blades 140, 142 each have arcuate shaped cutting surfaces 162.
  • the stationary blade portion 140 is integral with a housing assembly 166.
  • both blades 140, 142 include a blade edge 162 and an inflected surface 164.
  • the inflected surfaces 160 eliminate a gap between the blades 140, 142 when the blades are in a closed position.
  • the stationary blade portion 140 and the housing assembly 166 of the endoscopic surgical instrument 10 is shown having the blades 140, 142 in a closed position.
  • the inflected surfaces 160 of the blades 140, 142 cooperate to substantially eliminate any gap between the blades 140, 142 when the blades are in a closed position.
  • the inflected surfaces 164 substantially close any existing gap between the blades 140, 142.
  • the gap between blades without the inflected surface 164 is typically, for example, between 0.001 inches to 0.003. This is disadvantageous because a surgeon, in some cases, may not be able to achieve the clinical results desired, and for example, ripping or tearing of tissue may occur.
  • both blade edges have an inflected surface 164 directed towards each other that may be, for example, 0.001 inches to 0.002 inches toward the other blade.
  • the inflected surface 164 is preferably continuous along the blade edge 162, so that, the cooperation between the inflected surface 164 on the blades 140, 142 substantially closes the gap between the two blades, bringing the blades into substantial contact along the blade edge.
  • the inflected surface 164 on the blade edge 162 allows precision cutting of a specimen.
  • the endoscopic surgical instrument 10 thereby, allows a surgeon to achieve critical tolerances desired when performing certain surgical procedures.
  • the housing assembly 166 of the endoscopic surgical instrument 10 includes a pivot point 168 which allows the movable blade 142 to pivot in cooperation with the stationary blade 140.
  • the pivot point 168 preferably is offset from a horizontal diametric line in reference to the housing 166. It is understood that the pivot point 168 may also be positioned substantially about the horizontal diametric line.
  • the movable blade 142 is attached to the rod member 170 at its proximal end.
  • the rod member 170 pivots the movable blade 142 about the pivot point 168 in response to employment of the handle assembly 12.
  • the movable blade portion also includes an abutment portion at its proximal end, as described below.
  • the endoscopic surgical instrument 10 preferably includes an abutment surface 174 at its upper proximal region for preventing the blade members 140, 142 from becoming overstroked.
  • FIG. 19 there is illustrated blade members of an endoscopic surgical instrument which are overstroked. Overstroke occurs when one pivoting blade or both pivoting blades rotate past a desired closed position. As illustrated in Fig. 19 the blade has rotated past the closed position such that the point where the maximum amount of blade surface contacts is surpassed.
  • the housing assembly 166 of the endoscopic surgical instrument 10 of the present invention includes a longitudinal slot 172 substantially along a center line allowing the abutment surface 174 to protrude from the housing assembly 166.
  • a sleeve portion 176 is placed about the housing assembly 166 and is continuous with the outer tube 20.
  • the abutment surface 174 strikes the inner face 178 of the sleeve portion 176 to prevent the blades 140, 142 from becoming overstroked.
  • the rotating blade 142 pivots about the pivot point 168 to a desired closed position. At that position the abutment surface 174 at its proximal end communicates with the inner face 178 of the sleeve portion 176 by proceeding through the longitudinal slot 172 in the housing assembly 166, as shown in Figs. 22 and 23.
  • the sleeve portion 176 is preferably of a material stronger than the outer tube 20, thus, making the sleeve portion 176 reinforced.
  • the sleeve portion 176 may be, preferably, of steel and can withstand repeated strikes from the abutment surface 174 without deforming.
  • blade members may tend to separate when, for example, an endoscopic surgical instrument is used to dissect hard substances or opened and closed repeatedly. Because of the forces precipitated by the substances encountered, the blades may tend to move apart or splay from each other such that a gap between the blades becomes evident, or an existing gap increases.
  • the sleeve portion 176 may further be used for preventing the blade members 140, 142 from separating, as well as its use described above for receiving the abutment surface 174.
  • the sleeve portion 176 surrounds the housing assembly 166 such that the movable and stationary blades 142, 140 are coerced towards each other.
  • the endoscopic surgical instrument 10 outer tube 20 is for example, of aluminum.
  • Aluminum is typically insufficiently strong to prevent splaying of the blades.
  • the sleeve portion 176 may be made of steel, so that the sleeve portion 176 is sufficiently strong to inhibit movement of the blades 140, 142 apart from each other.
  • Endoscopic surgical cutting instrument 200 is similar to the surgical instruments disclosed above except for the novel cutting mechanism 210 positioned at the distal end of the elongated body portion 208.
  • Instrument 200 further includes handle assembly 202 which is comprised of pivoting handle 204 and stationary handle 206.
  • body portion 208 includes outer tube member 224 and inner rod member 226 which function as described above.
  • Inner rod 226 moves in response to movement of pivoting handle 204.
  • Body portion 208 terminates in cutting mechanism 210 which essentially is comprised of blade member 212 and blade member 214 secured at a distal end of body portion 208 at pivot point 216.
  • Blade members 212 and 214 pivot about pivot point 216 in response to movement of pivoting handle 204.
  • the pivoting handle 204 reciprocatingly moves inner rod member 226 to open and close cutting mechanism 210 through the provision of linkage mechanism 222.
  • the operation of instrument 200 is identical to that described above.
  • handle assembly 202 may include rotatable knob 218 to selectively position cutting mechanism 210 at any orientation about the longitudinal axis of the instrument. Handle 202 may also include provisions for electrocautery procedures through pin 220.
  • FIGs. 26 and 27 there is illustrated the blade members 212 and 214 of cutting mechanism 210.
  • Figs. 26A and 26B illustrate a first blade member 212, which for purposes of clarity may be considered the “bottom” blade.
  • Figs. 27A and 27B illustrate blade member 214, which again for purposes of this discussion, may be considered the "top” blade member.
  • blade member 212 includes blade portion 228 having a cutting edge 230 applied thereon during a grinding operation.
  • the blade member itself is preferably metal injection molded to be crescent shaped as seen in Fig. 26B.
  • Blade member 212 further includes camming portion 231 which is part of the linkage mechanism 222 described above.
  • Camming slot 232 is provided which functions identical to that described above in relation to Figs. 6A through 6C, and a hole is provided to accommodate pivot point 216 as shown.
  • Fig. 27A illustrates the top blade member 214, which is similar in construction to bottom blade member 212.
  • the radius of curvature at surface 236 of top blade member 214 is the same as the radius of curvature of bottom blade member 212 at surface 234.
  • Surfaces 234 and 236 represent the cutting surfaces of the blade members which face each other when the cutting mechanism is assembled. After assembly, however, the radius of curvature of blade member 214 is different than the radius of curvature of blade member 212 relative to pivot point 216, such that the radii of curvature are offset from each other.
  • the different radii of curvature relative to the pivot point 216 provides a cutting mechanism in which the blades contact each other during opening and closing at a single point and include a gap 244 between the blade members that "follows" the contact point 246 during closing. (See Fig. 31)
  • Figs. 29 and 30 there is illustrated cross-sectional views of blade members 212 and 214 taken along various points of the length of blade portion 228.
  • Figs. 29A through 29C illustrate top blade 214 and show inside surface 240 which faces bottom blade 212.
  • inside surface 236 is angled during the grinding of the blade member to apply cutting edge 230 to the blade member.
  • the inside surface 236 is angled towards cutting edge 230 to define a relief angle ⁇ which is less than 5° and preferably between 2° and 3°. The relief angle enhances the shearing action of the blades by angling the cutting edges 230 towards each other.
  • Figs. 30A through 30C illustrate the relief angle ⁇ on inside surface 234 for the bottom blade 212.
  • Figs. 31 and 32 illustrate the cutting mechanism 210 in an enlarged view, and the operation of cutting mechanism 210 will be described at this time.
  • cutting mechanism 210 is secured to outer tube 224 and pivots about pivot point 216, which essentially comprises a pin 217.
  • Cutting mechanism 210 is operable to open and close in response to movement of inner rod 226 which engages cutting mechanism 210 through linkage mechanism 222. The opening and closing of the mechanism is identical to that described above.
  • Blade members 212 and 214 are metal injection molded into a crescent shape and during assembly are provided with different radii of curvature relative to pivot point 216 as best seen in Fig. 31.
  • the radius of curvature of blade member 214 relative to pivot point 216 is offset from the radius of curvature of blade 212 and enhances the shearing action of the blade members during closing by providing for contact between the blade members at their cutting edge at a single point as the blade is closed.
  • the radius of curvature of blade 212 is offset from the radius of curvature of blade 214 by approximately 0.032 inches, so that gap 244 is provided and which is measured to be approximately 0.020 inches.
  • FIG. 31 shows the blades completely closed, and shows single contact point 246 at the distal end of the blade members
  • Fig. 32 shows the blade members 212 and 214 in the open position.
  • Contact point 246 moves along the cutting edges 230 as the blade members are opened and closed. Due to the differing radii of curvature relative to the pivot point 216, gap 244 is provided between the blades which follows the single contact point 246 as the blades are opened and closed.
  • Spring washer 238 provides additional means urging the blade members together to prevent separation of the blades in the event the tissue or stronger items such as staples or sutures are encountered.
  • spring washer 238 urges the blades towards each other.
  • the differing radii of curvature relative to the pivot point 216 causes the blades to contact at a single point 246 along the cutting edge 230.
  • the relief angle causes the blade members to taper towards the cutting edge to further ensure contact between the blades at the cutting edge 230.
  • the combination of the relief angle, the differing radii of curvature relative to the pivot point, the increased thickness of the blade members at the proximal end, and the spring washer 238 cooperate to enhance the cutting action of cutting mechanism 210 to shear tissue typically up to 0.035 inches in thickness.
  • Cutting mechanism 210 also provides for the cutting of sutures and staples during the endoscopic surgical procedure, if necessary.
  • the endoscopic surgical instrument of the present invention is a compact, lightweight and easy to use instrument incorporating many features required during endoscopic surgical procedures which allows the surgeon to use the instrument with one hand thus freeing his other hand for other purposes during the surgery.
  • the present instrument overcomes many of the disadvantages encountered with prior art devices and provides a precision instrument which is easy to handle and simple to manufacture.
EP9393115357A 1992-09-23 1993-09-23 Endoscopic surgical instrument Withdrawn EP0589454A3 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US95007492A 1992-09-23 1992-09-23
US950074 1992-09-23

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EP0589454A2 true EP0589454A2 (fr) 1994-03-30
EP0589454A3 EP0589454A3 (en) 1994-08-24

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